Topics in BMI: Course Objectives

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Topics in BMI Course Objectives
Prof. Steven A. Demurjian, Sr. Computer Science
Engineering Department The University of
Connecticut 371 Fairfield Road, Box U-255 Storrs,
CT 06269-2155
steve_at_engr.uconn.edu http//www.engr.uconn.edu/st
eve (860) 486 - 4818
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What is Informatics?

• Informatics is
• Management and Processing of Data
• From Multiple Sources/Contexts
• Involves Classification (Ontologies), Collection,
  Storage, Analysis, Dissemination
• Informatics is Multi-Disciplinary
• Computing (Model, Store, Process Information)
• Social Science (User Interactions, HCI)
• Statistics (Analysis)
• Informatics Can Apply to Multiple Domains
• Business, Biology, Fine Arts, Humanities
• Pharmacology, Nursing, Medicine, etc.

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What is Informatics?

• Heterogeneous Field Interaction between People,
  Information and Technology
• Computer Science and Engineering
• Social Science (Human Computer Interface)
• Information Science (Data Storage, Retrieval and
  Mining)

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What is Biomedical Informatics (BMI)?

• BMI is Information and its Usage Associated with
  the Research and Practice of Medicine Including
• Clinical Informatics for Patient Care
• Medical Record Personal Health Record
• Bioinformatics for Research/Biology to Bedside
• From Genomics To Proteomics
• Public Health Informatics (State and Federal)
• Tracking Trends in Public Sector
• Clinical Research Informatics
• Deidentified Repositories and Databases
• Facilitate Epidemiological Research and Ongong
  Clinical Studies (Drug Trails, Data Analysis,
  etc.)

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What are Key BMI Focal Areas?

• T1 Research
• Transition Bench Results into ? Clinical Research
  
• Clinical Research
• Applying Clinical Research Results via Trials
  with Patients on Medication, Devices, Treatment
  Plans
• T2 Research
• Translating Successful Clinical Trials into
  Practice and the Community
• Clinical Practice
• Tracking all of the Information Associated with a
  Patient and his/her Care
• Integrated and Inter-Disciplinary Information
  Spectrum

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Where/How is BMI Utilized?

• T1 Research (Bench ? Clinical)
• Transfer of Knowledge from Laboratory or Bench to
  Clinical Trials
• Move Genomic Research from Bench (Lab) to
  Clinical Trial (or Genetic/Test Intervention)
• Transfer in Lab/Bench Research to Pre-Clinical
  and Early Clinical Human Subject Research
• Exs
• New Genetic Test for Autism
• Tested on Samples from DNA Repository
• Transition to Actual Patient Population
• Growing new Jaw Bone in Mice for Dental Implants
  Transition to Human Tissue

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Where/How is BMI Utilized?

• Clinical Research (Trials)
• Wide Range of Implications from Medical Treatment
  to Medication Regime
• Multi-Phased Process for Clinical Trials
• Phase I First Stage 20-80 Healthy Patients
• Phase II Second Stage 20-300 Patients
• IIA Dosing How Much of Drug Should be Used
• IIB Efficacy How Well Does Drug Work
• Randomized Clinical Trials (Not all Get Drug)
• Phase III Multi-Center Trials 300-3000
• Longer Term, Data Collected, Multiple Locations
• Preparation of Data for Regulatory Approval (FDA)
• Phase IV Ongoing Monitoring of Drug After
  Approval

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Where/How is BMI Utilized?

• Clinical Research (Trials)
• Differing Perspectives for Carrying out Research
• Patients Drug, Treatment Regime, or Device
• Increased Dose of Existing Drug
  (Safety/Effective)
• Applying Drug to New Disease
• Compare Two or more Treatments
• Epidemiological
• Study Existing Data for Trend
• Against Existing Data Repositories
• Patients with CHF and Diabetes Taking Statins
• Tracking Communicable Disease/Outbreaks
• Phases I, II, III, and IV Apply
• Bad Results in IV Pull Drug (Vioxx)

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Where/How is BMI Utilized?

• T2 Research (Clinical Research?
  Practice/Community)
• Practice-Oriented Translation Research
• Results Clinical Trails ? Clinical Practice
• Strategies for Establishing/Implementing New
  Technologies
• Improvements in Practice
• New Evidence-Based Guidelines
• New Care Models
• Phase III Success Translated to Health Providers
• Examples
• Statin Drugs (Lipitor) and Exercise
• New Treatment Regime for Chronic Disease

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Where/How is BMI Utilized?

• Clinical Practice
• Dealing with Patients Direct Medical Care
• Hospital or Clinic
• Physicians Office
• Testing Facility
• Insurance/Reimbursement
• Tracking All Data Associated with Patients
• Medical Record
• Medical Tests (Lab, Diagnostic, Scans, etc.)
• Prescriptions
• Stringent Data Protection (HIPAA)
• Distributed Repositories, Inability to Access
  Data in Emergent Situations, Competition, etc.

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What is Medical Informatics?

• Clinical Informatics, Pharmacy Informatics
• Public Health Informatics
• Consumer Health Informatics
• Nursing Informatics
• Systems and People Issues
• Intended to Improve Clinical outcomes,
  Satisfaction and Efficiency
• Workflow Changes, Business Implications,
  Implementation, etc
• Patient Centered Personal Health Record and
  Medical Home
• Care Centered Pay for Performance, Improving
  Treatment Compliance

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What is Bionformatics?

• Focused on Research Tools for T1
• Genomic and Proteomic Tools, Evaluation Methods,
  Computing And Database Needs
• Information Retrieval and Manipulation of Large
  Distributed (caBIG) Data Sets (cabig.cancer.gov/in
  dex.asp)
• Often Requires Grid Computing
• Includes Cancer and Immunology Research
• Increasing Need to Tie These Separate Types of
  Systems Together Personalized Medicine
• Biology and the Bedside (www.i2b2.org)

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Where is Data/How is it Used?

• Medical And Administrative Data Found in Clinical
  Information Systems (CIS) Such As
• Hospital Info. Systems Electronic Medical Records
• Personal Health Records such as Google Health and
  Microsoft Healthvault
• Pharmacy, Nursing, Picture Archiving Systems
• Complex Data Storage and Retrieval Many
  Different Systems
• T1 Research Increasingly Reliant on CIS
• T2 Research is Reliant on
• End Systems for Embedding EBM (Evidence-Based
  Medicine) Guidelines
• Measuring Outcomes, Looking at Policy

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What are Major Informatics Challenges?

• Shortage of Trained People Nationally
• Slows adoption of Health Information Technology
• Results in Poor Planning and Coordination,
  Duplication of Efforts and Incomplete Evaluation
• What are Critical Needs?
• Dually Trained Clinicians or Researchers in
  Leadership of some Initiatives
• Connect all folks with Informatics Roles across
  Institutions to Improve Efficiency
• Multi-Disciplinary CSE, Statistics, Biology,
  Medicine, Nursing, Pharmacy, etc.
• Emerging Standards for Information Modeling and
  Exchange (www.hl7.org) based on XML

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What is UConn Doing in this Area?

• NIHs CTSA Program Transform the Way Clinical
  and Translational Science Research is Conducted
• From Bench to Clinical Research to Translational
  Research to the Bedside and Back Again
• 45 Academic Medical Centers Awarded to Datesee
  http//www.ctsaweb.org/
• Under President Mike Hogans Leadership
• UConn Submitted a CTSA Proposal in Oct 2008
• Formed CICaTS Connecticut Institute for Clinical
  and Translational Science (Sept. 29th 09)
• University Initiative with Partners
• John Dempsey, St. Francis, Hartford Hospital,
  CCMC, Hospital for Central CT, Institute for
  Living, etc.
• http//cicats.uconn.edu/

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CICATS

• Official Launching
• Tuesday September 29, 1030am-130pm
• UConn Global Business Learning Center, Hartford
• Speakers Include Pres. M. Hogan, Provost P.
  Nichols, and Dean Cato Laurencin (Med School)
• Mission
• to educate and nurture new scientists
• to increase clinical and translational
  research being conducted at UCHC, regional
  hospitals, UConn Storrs, and healthcare
  organizations throughout greater Hartford 
• to work collaboratively with regional
  stakeholders to combat the leading causes of
  morbidity, mortality, disability, and health
  disparities
• CICATS will have Biomedical Informatics Center

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Biomedical Informatics in CICATS
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Summary of Web Sites of Note

• AMIA (www.amia.org)
• IHE (http//www.ihe.net/)
• Smartplatform (http//www.smartplatforms.org/)
• Mysis MOSS (http//www.misys.com/OpenSource)
• NSF Clinical and Translational Science Program
• http//www.ctsaweb.org/
• Emerging Patient Data Standard
• http//www.hl7.org/
• Informatics for Integrating Biology the
  Bedside.
• https//www.i2b2.org/
• Cancer Biomedical Informatics Grid
• http//cabig.cancer.gov/index.asp

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Semester Topics (weeks)

• Four Core Topics
• Semester and Course Overview (0.5)
• Informatics/Information Engineering (1.5)
• Software Architectures (2)
• Security and Dynamic Coalition Problem (2)
• Service Based Computing (2)
• CORBA, JINI, .NET, Interoperability, Web
• Security
• Discussion of Semester Project (0.5)
• Presentations by Outside Speakers (2.5)
• Student Presentations on Biomedical Informatics
  Materials (3)

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Planned Speakers

• Dr. L. Fagan, Co-Director, Stanford Biomedical
  Informatics Training Program, March 31
• Dr. M. Smith, Pharmacy Practice, UConn, April 5
• Dr. T. Shortliffe, President, AMIA, April 28
• Others to be Scheduled
• Dr. Thomas Agresta
• Dr. Michael Blechner
• Dr. Xiaoyan Wang

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Class Materials, Textbook, Projects, etc.

• Course Web Site http//www.engr.uconn.edu/steve/
  Cse300/cse300.html
• Reading List
• Constant Updates and Changes
• Textbook
• Biomedical Informatics Computer Applications in
  Health Care and Biomedicine (Health Informatics),
  Edward H. Shortliffe (Editor), James J. Cimino
  (Editor), ISBN-10 0387289860
• Project 1 Due in 2 weeks
• Project 2 Out in 2 weeks
• Team Project Out in 2 weeks as well
• Questions? Comments? Suggestions?

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Course Projects and Exam (???)

• Individual/Team Course Project(s) Throughout the
  Semester
• Individual Projects have two Goals
• Increase Student Knowledge on BMI
• Assist in Creating Courseware
• Project will be the Entire Class
• Explore and Learn about BMI Technologies
• Span Subset of T1 Research - Clinical Research -
  T2 Research - Clinical Practice
• Explore Open Source and Other Solutions
• Develop Extensible Plug and Play Framework
• Exam At MOST Final Exam (Still open to debate!)

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Individual Semester Projects

• Readings, Readings, and More Readings
• Project 1 Annotated Bibliography
• Accumulate Web/Hard Links on T1 Research -
  Clinical Research - T2 Research - Clinical
  Practice
• Read 7 Papers on Clinical Translational
  Science
• Project 2 Courseware Materials
• Choose two Different Areas for Indepth
  Examination
• Topics include (but not Limited to)
• HIE I2b2
• Standards (HL7, Common Data Architecture CDA)
• caBIG
• BIRN (Biomedical Informatics Research Network)
• Another NIH Computing Initiative

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Semester Project

• Still Evolving Possible Projects Include
• Usage of SmartPlatform
• Utilization of Personal Health Records (PHR) Such
  as Google Health and/or MS Healthvault in New or
  Extended Context
• Interoperability with EMR
• Google Health Hibernate API Available
• XML (HL7/CDA) to i2b2 DB Translation
• Supervised by M. Blechner (UCHC BMI Faculty)
• Extending Cell Phone Applications (iphone,
  blackberry, and android) for
• Maintaining Prescriptions
• Observations of Daily Living
• Prior Work by Undergraduate Teams (with Source)

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Semester Project Objectives

• Objective Wide Scale Open Source Framework
• Envision Plug and Play Architecture
• High Reliance on Open Source Solutions for PHR
  and EMR
• Support Interoperability to Components via XML
  and Standards
• Develop Complete, Integrated, and Extensible
  Framework

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SmartPlatform

• Substitutable Medical Apps, reusable technology
• (http//www.smartplatforms.org/)
• NSF/NIH Funded SHARP Proposal at Harvard
• Intended toA platform with substitutable apps
  constructed around core services is a promising
  approach to driving down healthcare costs,
  supporting standards evolution, accommodating
  differences in care workflow, fostering
  competition in the market, and accelerating
  innovation
• Likely Led by Timo Ziminski

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Personal Health Records

• Google Health
• Detailed Hibernate API to Allow Programmatic
  Transfer of Information to/From Google Health
• Utilized in Web-Based Application
• Utilized by Cell Phone Projects (see later
  slides)
• Existing Platform Available for Future Design,
  Development, and Usage
• Explore EMR/PHR Interoperability

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TMR Architecture
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XML (HL7/CDA) to i2b2 DB Translation

• Work with Dr. Michael Blechner (UCHC BMI Faculty
  Member)
• Explore a Prototype that can take
• HL7/CDA Data (Simulated from an EMR)
• Store in a i2b2 Compatible Database
• Utilization of Standards, New Technologies, etc.

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Cell Phone Applications

• RWJ Project Health Design
• Observations of Daily Living and PHRs
• Passive Once Initiated, Collects Data
• Accelerometer
• Pedometer
• Pill Bottle that Sends a Time Stamp Message (over
  Bluetooth?) to SmartPhone
• Active Patient Initiated
• Providing Information via Smartphone on
• Diabetes (Glucose, Weight, Insulin)
• Asthma (Peak Flow, use of Inhaler)
• Heart Disease (Pulse, BP, Diet)
• Pain, Functional status, Fatigue, etc.
• http//www.engr.uconn.edu/steve/Cse4904/cse4904.h
  tml

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Focus of Grant

• Management of Two Diseases in Women of Color
• Obesity and Osteoarthritis
• Team
• TRIPP (Crowell, Fifield) and AHFP (Agresta)
• SisterTalk (Headley) and CHCAT (Granger)
• UConn Storrs (Demurjian) and Netsoft (Collins)

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CSE4904 Spring 2010

• Smartphone Projects on ODLs and Other Medical
  Data Tracking and Alerts
• Three Platforms
• Googles Android (Java)
• Blackberry (Java)
• iPhone (Objective C)
• Three Teams of Three Students Each

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Blackberry Team

• Ability to Track Information on ODLs and
  Prescriptions
• Login Screen
• Connection to Google Health
• Health Screen to Track ODLs
• Charting of ODLs over Time
• Loading Scripts from Google Health
• Prescription Alarms
• Adam Siena, Kristopher Collins, William Fidrych

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Android Team

• Similar Capabilities to Blackberry Project
• Wellness Diary and Medication Alarm
• Integration with Google Health
• Much Improved ODL Screens
• Male and Female Faces
• Change Face Based on Value
• Tracking Prescriptions and Alarms
• Reports via. Google Charts
• Ishmael Smyrnow, Kevin Morillo, James Redway

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iPhone Team

• Similar Capabilities to Blackberry Project
• Tracking of Conditions, Medications, and
  Allergies
• ODLs for
• Blood-Glucose, Peak-Flow, and Hypertension
• Generation of Reports
• Synchronization with Google Health
• Brendan Heckman, Ryan McGivern, Matthew Fusaro

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Questions?